Friday, February 5, 2010

This is a reprint of a CNS article from yesterday that was about the recent research that proved that some unresponsive people have respond to questions.

The article:

Reacting to news of a breakthrough in brain scanning technology, Terri Schiavo's brother Bobby Schindler is calling for a halt to removing hydration from brain-damaged patients who are thought to be in a persistent vegetative state.

An “unscientific, inaccurate” diagnosis of unresponsive patients is being used as “a criterion to kill,” Schindler charged.

Schindler was responding to news that researchers from the Medical Research Council (MRC) and the University of Liège have used a technique called functional magnetic resonance imaging (fMRI) to map a patient’s brain activity while he was asked to answer ‘yes’ or ‘no’ questions.

One patient, a 29-year-old man who suffered a severe traumatic brain injury in a traffic accident, was able to communicate by willfully changing his brain activity, a press release from the MRC reports. He correctly answered questions such as “Is your father’s name Alexander?”

Dr. Adrian Owen and his team at the MRC Cognition and Brain Sciences Unit in Cambridge, England were the developers of the technique.

“We were astonished when we saw the results of the patient’s scan and that he was able to correctly answer the questions that were asked by simply changing his thoughts,” Dr. Owen commented. “Not only did these scans tell us that the patient was not in a vegetative state but, more importantly, for the first time in five years, it provided the patient with a way of communicating his thoughts to the outside world.”

Dr. Steven Laureys of the University of Liège, a co-author of the study, said the scans were the only viable method for the patient to communicate since his accident.

“It’s early days, but in the future we hope to develop this technique to allow some patients to express their feelings and thoughts, control their environment and increase their quality of life.”

The three-year study conducted fMRI scans on 23 patients diagnosed as being in a vegetative state. The technology detected signs of awareness in four of the cases, 17 percent of the participants.

The fMRI technique can decipher the brain’s answers to questions in healthy participants with 100 percent accuracy but has previously not been used for a patient who cannot move or speak.

Dr. Martin Monti, another MRC co-author of the study, said the advance could help with clinical questions and would allow patients to say if they are feeling any pain.

The new study is published in the New England Journal of Medicine.

Dr. Allan Ropper, a neurologist at Brigham and Women's Hospital in Boston, wrote an editorial accompanying the study. According to HealthDay News, he said that people are going to have to “grapple” with the meaning of brain scans that show consciousness or residual consciousness.

“It has to do with what you think life is and what is a meaningful life. Those are social, cultural and theological questions,” he said.

He also cautioned against giving false hope to families, noting the small percentage of the responsive patients. All the study’s patients had suffered traumatic brain injuries, not damage from oxygen deprivation.

Speaking of the 29-year-old patient, Monti said “it is still the case that we managed to give him, to a little extent, a voice. In a sense there was a very positive outcome. We managed to interact. This is an extremely exciting thing."

CNA sought comment on the issue from Bobby Schindler of the Terri Schiavo Foundation.

His sister Terri, who was severely brain damaged from oxygen deprivation, was at the center of a 2005 legal dispute in Florida. She was denied nutrition and hydration by court order in a case between her blood relatives and her husband.

Schindler said the study backs other findings about the “unscientific, inaccurate” diagnosis of a persistent vegetative state (PVS) and shows how it is “often” wrong when diagnosing people with severe injuries.

“As in the case of my sister, they’re using this diagnosis as a criterion to kill.”

Schindler said his family had asked a judge for similar testing for Terri but it was denied.

If the technique was easy to conduct and available, he said, it would have given a better understanding of her condition. “Why not ask, especially when it is going to end someone’s life?”

Asked whether the case offers insight into how unresponsive patients should be treated, he replied:

“Nobody should have to earn the right to hydration. We should do everything we can to care for these people, regardless of how responsive or unresponsive they are.”

Schindler lamented that people are being “indoctrinated” to see killing as “an act of compassion.”

“We are morally obligated to care for these people,” Schindler told CNA.

“They should stop any further dehydration deaths, because we’re learning how inaccurate the PVS diagnosis is.”

Discussing the other patients who could not communicate, he said families of unresponsive patients should continue to treat them with “love and compassion.”

But the patient’s condition should never justify removing food, hydration or “basic care,” he stressed.

Schindler also noted that improvements on science are possible and could improve unresponsive patients’ functioning.

“We should never come to the conclusion that someone is better off starving to death,” he told CNA.

He was critical of news reports that claimed the new technology would not have helped Terri Schiavo, saying some stories were written “as if these doctors want to go out of their way to justify Terri’s death.”

“If you read these articles, it seems they always have this caveat: ‘let’s not jump to conclusions with Terri Schiavo and say these tests would have proven she wasn’t in the conditions the doctors said she was in.’”

Schindler told CNA that more doctors were on record saying that Terri could have been helped with some of the technology available. They believed that she wasn’t in a vegetative state.

He also advocated the elimination of the term “vegetative state” from common use, saying it is “dehumanizing” and devalues the person and his or her “inherent moral worth.” In his view, PVS diagnosis should also not be used as a criterion for ending someone’s life because of how often it is wrong.

Schindler said he describes unresponsive patients as “persons with brain injuries.”

“I don’t know why I have to label them as being a vegetable. I think it leads to an existing prejudice against these types of people,” he told CNA.